A REVIEW OF THE MANAGEMENT OF RECTAL CHLAMYDIA IN THREE CLINICS BEFORE AND DURING THE COVID-19 PANDEMIC

Background The British Association for Sexual Health and HIV guidelines for the management of rectal chlamydia recommend 1 week of doxycycline and testing for Lymphogranuloma venereum (LGV). Any difficulties in recalling LGV positive patients to extend the script to three weeks could cause treatment gaps or necessitate restarting treatment. Alternatively, a 3-week prescription can be given immediately, and the patient then instructed to stop if LGV negative. However, this approach raises concerns about potential antibiotic overuse if patients are hard to contact. This audit considers whether this proactive approach is indicated. Method Electronic patient records were reviewed to identify patients coded as C4 in 2020 and the first half of 2019 in one hospital and two community clinics. From these, patients with rectal chlamydia were selected. The following were recorded;rectal symptoms/signs, LGV swabs taken before/at time of treatment, treatment regime/duration, LGV results, HIV status, whether patients were contacted with LGV results. Results In 2020, of the 146 rectal chlamydia positive patients 75% were tested for LGV and 30% were prescribed 3 weeks of doxycycline. 4 patients tested positive with LGV. In the 2019 sample, 78% of the 55 rectal chlamydia positive patients were tested for LGV and 20% were prescribed 3 weeks of doxycycline. Only 1 tested LGV positive. Conclusion Low rates of LGV positivity suggest adhering to the recommendation of 1 week of doxycycline is advisable to avoid antibiotic overuse and potential associated resistance.

A REVIEW OF THE MANAGEMENT OF PELVIC INFLAMMATORY DISEASE AT A COMMUNITY CLINIC COMPARING PRACTICES BEFORE AND DURING THE COVID-19 PANDEMIC

Background Pelvic inflammatory disease (PID) usually results from infection ascending from the endocervix. The British Association for Sexual Health and HIV guidelines state that the diagnosis of PID should be considered in women under 25 with recent onset, bilateral lower abdominal pain and local tenderness on bimanual examination where pregnancy has been excluded. They recommend testing for chlamydia, gonorrhoea and mycoplasma genitalium. Method Electronic patient records were reviewed to identify episodes coded C5A during the last six months of 2019 and 2020. 46 patients were identified in 2019 and 43 in 2020. The following were recorded: demographics, symptoms, sexual history, examination findings, investigations, treatment, partner notification, follow-up. Results The age range of the 89 patients was 18-62, 51% were aged 25-34. Patients came from a range of ethnicities reflecting the diverse population. All patients were tested for chlamydia and gonorrhoea, none for mycoplasma genitalium. A pregnancy test was not performed in 19/89 (21%) patients. Documentation of examination findings was sometimes absent. Follow-up was recorded in 8/89 (9%) cases. Results were similar in 2019 and 2020, although ceftriaxone administration was more common pre-pandemic. Key results are summarised in the accompanying table 1. Conclusions PID management in 2019 and 2020 was similar. Increased testing for mycoplasma could guide antibiotic therapy. The importance of pregnancy testing in women presenting with lower abdominal pain should be highlighted to clinicians. Telephone calls could be used to facilitate follow-up appointments. (Figure Presented).

A review of practice comparing self-taken versus physician taken cultures for gonorrhoea at two clinic sites

Background: The number of gonorrhoea infections continue to rise during the COVID-19 pandemic. With the current restrictions in place patients are encouraged to test online. Obtaining culture is a crucial part of gonorrhoea management and not possible online. When patients attend clinics it is imperative to ensure contact is brief and examinations are conducted only if deemed necessary. Two clinics collaborated on reviewing the practice of taking swabs for culture either performed by the clinician or the patient. Site 1 maintained their pre-COVID practice of taking endo-cervical swabs for culture and Site 2 switched to patient taken vulvovaginal cultures to reduce patient contact .The aim of this review was to determine whether either method of sampling affected the culture result. Method: A retrospective review of the electronic patient records (EPR) was conducted and all female patients with a positive gonorrhoea diagnosis were selected. The audited period covered was June 2020-November 2020. Forty patients were selected in total with 20 from each site. The following were recorded demographics, patient taken or clinician taken samples, sites which tested positive, culture results, treatment, antibiotic sensitivities and test of cure. Results: Of the forty patients audited 97.5% (39/40) were heterosexual and 2.5% (1/40) bisexual. All GC positive samples had culture taken prior to treatment. 47.5% (19/40) were clinician taken endo-cervical cultures. 52.5% (21/40) self-taken VVS. All the endo-cervical swabs were taken at GU site 1 and the vulvovaginal swabs at site 2 From the clinician taken samples 63% (12/19) had no growth and only 37% ( 7/19) moderate growth. In the self-taken samples, 71% (15/40) had no growth, 24% (5/21) had a moderate growth and 5% (1/21) had scanty growth of GC. 97.5% (39/40) cases received Ceftriaxone. 2.5% (1/40) given ciprofloxacin. 70% (28/40) of the patients had a TOC done after 2wks, and only 30% (12/40) failed to return. All samples were sensitive to first line GC treatment. Conclusion: There was no significant difference between the clinician and patient taken swabs for culture. Given the current climate and the need to reduce risks of the coronavirus, patient taken cultures should be encouraged.

A collaborative approach to maintaining optimal inventory and mitigating stockout risks during a pandemic: capabilities for enabling health-care supply chain resilience

Purpose: Inventory management systems in health-care supply chains (HCSC) have been pushed to breaking point by the COVID-19 pandemic. Unanticipated demand shocks due to stockpiling of medical supplies caused stockouts, and the stockouts triggered systematic supply chain (SC) disruptions inconceivable for risk managers working individually with limited information about the pandemic. The purpose of this paper is to respond to calls from the United Nations (UN) and World Health Organization (WHO) for coordinated global action by proposing a research agenda based on a review of current knowledge and knowledge gaps on the role of collaboration in HCSCs in maintaining optimal stock levels and reinforcing resilience against stockout disruptions during pandemics. Design/methodology/approach: A systematic review was conducted, and a total of 752 articles were analyzed. Findings: Collaborative planning, forecasting and replenishment practices are under-researched in the HCSC literature. Similarly, a fragmented application of extant SC collaborative risk management capabilities undermines efforts to enhance resilience against systematic disruptions from medical stockouts. The paucity of HCSC articles in humanitarian logistics and SC journals indicates a need for more research interlinking two interdependent yet critical fields in responding to pandemics. Research limitations/implications: Although based on an exhaustive search of academic articles addressing HCSCs, there is a possibility of having overlooked other studies due to search variations in language controls, differences in publication cycle time and database search engines. Originality/value: The paper relies on COVID-19's uniqueness to highlight the limitations in optimization and individualistic approaches to managing medical inventory and stockout risks in HCSCs. The paper proposes a shift from a fragmented to holistic application of relevant collaboration practices and capabilities to enhance the resilience of HCSCs against stockout ripple effects during future pandemics. The study propositions and suggestion for an SC learning curve provide an interdisciplinary research agenda to trigger early preparation of a coordinated HCSC and humanitarian logistics response to future pandemics. © 2021, Emerald Publishing Limited.